Intention to use digital mental health solutions: A cross-sectional survey of university students attitudes and perceptions toward online therapy, mental health apps, and chatbots.

Background: Globally, the high prevalence of mental disorders among university students is a growing public health problem, yet a small minority of students with mental health problems receive treatment. Digital mental health solutions could bridge treatment gaps and overcome many barriers students face accessing treatment. However, there is scant evidence, especially in South Africa (SA), relating to university students' use of and intention to use digital mental health solutions or their attitudes towards these technologies. We aim to explore university 2students attitudes towards and perceptions of digital mental health solutions, and the factors associated with their intention to use them. Methods: University students from four SA universities (n = 17 838) completed an online survey to assess experience with, attitudes and perceptions of, and intentions to use, digital mental health solutions. We conducted an exploratory factor analysis to identify factors underlying attitudes and perceptions, and then used multivariate ordinal regression analysis was used to investigate the factors' association with students' intention to use digital mental health solutions. Results: Intention to use digital mental health solutions was high, and attitudes towards and perceptions of digital mental health solutions were largely positive. Importantly, our analysis also shows that 12.6% of users were willing to utilise some form of digital mental health solutions but were unwilling to utilise traditional face-to-face therapies. The greatest proportion of variance was explained by the factor 'Attitudes towards digital technologies' utility to improve student counselling services, provided they are safe'. Conclusion: SA university students are already engaging with digital mental health solutions, and their intention to do so is high. Certain attitudes and perceptions, particularly concerning the utility, effectiveness, and safety, underlie willingness to engage with these solutions, providing potential targets for interventions to increase uptake.

Perceptions and experiences of patients attending an opioid substitution clinic in South Africa.

Background: Opioid substitution therapy (OST) is endorsed as the recommended treatment for opioid use disorders. Opioid substitution therapy is not widely used in South Africa, so little is known about its perceived clinical utility in this setting. There is also a paucity of qualitative research that explores the subjective experiences of patients using OST. Aim: To explore patients' perceptions and experiences attending a South African OST outpatient clinic (OST-OC). Setting: The OST-OC at Stikland Psychiatric Hospital, Cape Town, South Africa. Methods: We conducted a qualitative study using semi-structured interviews with eight participants who had been attending the OST-OC for at least 6 months. Transcripts were analysed using Atlas.ti software and thematic content analysis was used to identify themes. Results: Patients stated that OST helped them to regain and maintain a stable lifestyle. Autonomy and agency, the therapeutic relationship and family support were perceived as contributing to successful patient outcomes. The preference for methadone and buprenorphine treatment depended on individual experiences. Patients valued kindness from staff members but reported that improved interactions with some nonclinical staff could better facilitate treatment. Challenges experienced included stigma and cost. Conclusions: This study offers insights about OST that are pertinent to low- and middle-income countries. Reducing the cost of OST, collaborative decision-making between staff and patients, and a non-judgemental attitude by clinical staff were recognised as important factors for optimised service delivery. Contribution: Understanding patients' experiences of OST in a South African setting will allow for future policy development for the treatment of opioid use disorders in similar settings locally and abroad.

Characteristics of inpatients in dialectical behaviour therapy modified for a resource-limited setting.

BACKGROUND: Emotional dysregulation in psychiatric disorders contributes to morbidity, mortality and healthcare costs. Dialectical behaviour therapy (DBT) is effective in addressing this, but is complex and costly to implement. Recent literature indicates that DBT can be modified for use in resource-limited settings, but little is known about its implementation in African settings. AIM: To describe the demographic and clinical characteristics of participants in a modified DBT-ST (skills training) programme at a South African psychiatric hospital. SETTING: The study was conducted at Stikland Hospital, a public psychiatric hospital in the Western Cape province, South Africa. METHODS: A retrospective, cross-sectional chart review of patients included in a modified inpatient DBT-ST programme between 30 June 2014 and 30 June 2019 was conducted. Descriptive analyses were performed on the data both as a complete set and after division into several subgroups. RESULTS: We included 349 records. Two-thirds of the patients completed the programme. Major depressive disorder, borderline personality disorder and substance use disorder were the most prevalent diagnoses. Most patients had psychiatric comorbidities. A total of 90.61% (n = 309) of the patients were exposed to at least one traumatic event and three-quarters (n = 261) had attempted suicide at least once before. CONCLUSIONS: The demographics of our sample did not differ markedly from the international literature. Rather, what stood out was that modified DBT-ST could be a choice in resource-limited settings for a diagnostically heterogeneous group that displayed significant clinical complexity and high levels of emotional dysregulation. Our findings might suggest that the intervention was well tolerated and possibly most appropriately delivered at the first admission, although further research is required.